DrVirgo
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A 43 year old man is evaluated for a one-year history of chronic abdominal pain. He describes episodes of epigastric and left upper quadrant pain that lasts for hours and are not relieved by antacids. Certain foods can percipitate the pain. He also complains of occasional diarrhea. The patient has lost 10 pounds over the last 6 months. Four years ago he was hospitalized for three days with acute abdominal pain. He smokes one pack of cigarettes a day and consumes alcohol regularly. His family history is significant for DM in his mother and prostate cancer in his father. Which of the following is most likely to diagnose this patient's condition?
A. D-xylose absorption test
B. Serum amylase and lipase
C. HIDA scan
D. CA 19-9 and CEA levels
E. Stool elastase
F. Upper GI endoscopy
G. Liver biopsy
What does this man have? What other test could use to diagnose this (not in the answer choices).
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| hanialkhadher
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B.
He has Ch.Pancreatitis, Do C.T.
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| DrVirgo
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Chronic pancreatitis is the right answer but B is not right.
By the time it becomes chronic, the amylase and lipase levels have returned back to normal because the pancreases is "juiced out" or fibrosed, etc...
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| krsna
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i thot it was B too, wats the correct answer!
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| Aashi
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E ) Stool elastase------>best dxoc for chronic pancreatitis
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| DrVirgo
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E is right.
What about the secretin stimulation test??? (that was not even a choice) but it is also a good diagnostic test for chronic pancreatitis.
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| hanialkhadher
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NOTE: CMDT2004 (Elastase & chemotrypsin in Stool lacks sensetivity & specificity)
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| DrVirgo
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Aashi wrote:
E ) Stool elastase------>best dxoc for chronic pancreatitis
Thanks aashi... I know you are always right in your explanations, but I was just wondering the source of the above statement because it says the opposite in CMDT.
Thanks. 
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| Aashi
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Dear Dr.virgo
My source is UW,and i remember this q,though i gave my step 2, 2 months back..pasting down a statement from emedicine---> http://www.emedicine.com/med/topic1721.htm
- Because maldigestion and malabsorption do not occur until more than 90% of the pancreas has been destroyed, steatorrhea is a manifestation of advanced chronic pancreatitis, and neither qualitative nor quantitative fecal fat analysis can detect early disease.
- Assays of fecal chymotrypsin and human pancreatic elastase 1 have the same limitations but are useful in confirming advanced chronic pancreatitis with exocrine insufficiency.
GL
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| nsomarajan
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I found this in UpToDate about chronic pancreatitis.
Serum concentrations of amylase and lipase may be slightly elevated in patients with chronic pancreatitis, but are more commonly normal for the following reasons:
- Chronic pancreatitis is a patchy, focal disease, leading to a minimal increase in pancreatic enzymes within the blood.
- There is frequently significant fibrosis, resulting in decreased concentrations of these enzymes within the pancreas.
The absolute serum concentrations of amylase and lipase have no prognostic significance.
Measurement of fecal elastase can be helpful for evaluating pancreatic exocrine dysfunction. Among pancreatic function tests, fecal elastase measurement is the most sensitive and specific, especially in the early phases of pancreatic insufficiency. In addition, its values are independent of pancreatic enzyme replacement therapy and require only a single random stool sample.
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